The long-awaited date

May 11, 2007
Thats it. The day I'm having surgery.... again.
I've been waiting for a while now to know for sure because there were some schedualing difficulties. But I've been given the official word now, so there you go.

History: My surgeon has been telling me since November that it was time to stop trying to fix the fistula and face the facts that it cannot be fixed and I need to move on with my life. He did want me to get a 2nd opinion from the Chief of colorectal surgery, Dr Fazio, just so we would both feel that we gave this 100% and not have any questions. So in January I had a consult with Dr Fazio who agreed with Dr Remzi (I expected nothing less) and I eventually came to agree with them both. In February we talked about what we could to to alleviate my present distress, in March we agreed and got to work setting a surgery date and in April I got my date set.

My options were presented as follows:
1 - Leave me as I am - Not acceptable to me as I am having horrible draining 24/7
2 - Redo j-pouch - Not presented as a good option with likelihood of poor pouch function, chance of fistula recurrence and likelihood that the crohns disease would spread to my new pouch.
3 - Permanent end ileostomy - presented as BEST option because conserves the most bowel. However this option is very unattractive to me as I hate the appliance I have to wear all the time, and the thought of having it for the rest of my life is very difficult.
4 - Kock pouch - called a "continent ileostomy" kinda a hybrid of ileostomy and j-pouch, it is an internal pouch made from the small intestine and I would still have a stoma, however there is no external appliance. The pouch is emptied with a catheter. Check out my posting on the K-pouch for all the details. The pro of this being that the pouch is internal and there is no need for an appliance, I would just wear a patch to cover the stoma. The cons are #1 because it is made from my small intestine there is a chance that the crohns disease could spread to my new pouch. #2 The surgery is difficult and has a very high complication and re-operation rate.

After much prayerful consideration and talking with my family and doing a LOT of thinking I have opted to go with the kock pouch. It will bring me the closest to "normal" that I can ever be again since living with the fistula is out of the question. I will be having my j-pouch removed along with the sphincter muscles and remaining rectal cuff and my rear-end will be sewn up tight. As you can imagine this was a very difficult decision for me to make as there is no going back and it will be an emotionally and physically painful experience.

As I mentioned above the kock pouch is a very difficult procedure with a high complication rate such that there are only about a dozen surgeons in the US that do them. My surgeon, Dr Remzi is one of them and the chief of colorectal surgery Dr Fazio is famous for his skill at doing them (has done over 500). Part of the problem in getting my surgery scheduled was that they will be doing this part of the surgery together and its difficult to get two very busy surgeons together at the same time. I feel confident that they will do a fantastic job. As you have no doubt gathered, The k-pouch is a very big surgery and also having my j-pouch removed is also a major procedure so you can imagine that I am nervous. As much surgery as I've had its still not easy to be wheeled into the OR.

Here's the nitty-gritty:
Surgery is expected to last 4-6 hours
I'll have a 5-8 inch incision.
I will be hospitalized 5-7 days
My recovery period is 6-8 weeks

My diet will be severely limited for several months and there will be a huge period of adjustment as I get accustomed to my new alternative plumbing situation. Also, having all the sphincter muscles removed and that area sewn up will be painful for quite some time. I would very much appreciate your prayers as I try and prepare myself physically, emotionally and mentally for the challenges ahead.

My mom is coming home from Thailand to be with me and help Shon take care of me, and I would appreciate your prayers for her too as the travel time is in the range of 36 hours.

What else can you pray for?
That the surgery will go well with no major complications
That I have a speedy recovery!
That my mom and I won't drive each other crazy :)
That I'll adjust to my new pouch well.
That God will provide for our needs while I'm out of work
That God will comfort my family and provide them with peace - especially Shon. As hard as it is for me to go through all this, I know it is harder on my family.

On a side note:
Last February I had surgery to repair the fistula and give me a "temporary" ileostomy. The day after surgery, after I had been out of bed a little while, I laid down to take a nap and shortly thereafter stopped breathing - I had a severe allergic reaction to some medication that I was on. Fortunately the nurse came in to check on me and noticed that I was unresponsive, she called a "code blue" and the crash team came in and revived me. I do not know how long I was unconscious. My family was forced out of the room, a policeman was stationed outside and a pastor was sent up to talk to them. Thankfully they were able to revive me without any of the serious or invasive measures such as intubating or paddles but I woke up with a dozen doctors and nurses working on me, with an oxygen mask on my face, and with monitors all over my body. It was a terrifying experience for both me and my family

They THINK they figured out what I'm allergic to, but I was on 5-6 different kinds of medication at the time and therefore I still have concerns about the accuracy of their determination. Because of this, one my fears about the upcoming surgery is actually how I'll do the day after . I'd appreciate your prayers.

Thank you all for your love and support!